Section 4305. Group contracts

(a) A corporation subject to the provisions
  of this article may issue  a  group  contract,  provided  the  group  of
  persons  thereby covered conforms to the requirements of subsections (c)
  and  (d)  of  section  four  thousand  two  hundred  thirty-five  or  of
  subparagraph  (C)  of  paragraph three of subsection (a) of section four
  thousand two hundred thirty-seven of this  chapter,  and  provided  such
  contract  and the individual certificates issued to members of the group
  shall comply in substance with this article. A  corporation  subject  to
  the  provisions of this article shall issue to the group contractholder,
  for delivery to each  member  of  the  insured  group,  a  copy  of  the
  contract, or a certificate which can be in the form of a booklet setting
  forth  in  summary  form  a  statement  of the essential features of the
  insurance coverage. A group contract issued  pursuant  to  this  section
  shall be subject to subsections (k) and (l) of section four thousand two
  hundred thirty-five of this chapter.
    (b) Any such contract which provides for the adjustment of the rate of
  premium  based upon the experience thereunder shall specify the duration
  of the period of insurance thereunder;  such  period  shall  not  exceed
  three  years, provided, however, that such contract may provide that, in
  the absence of one month's prior written notice by either party  to  the
  other,  it  shall  be  automatically  renewed  at the termination of any
  period thereunder for a succeeding period of not less than one nor  more
  than  three  years'  duration.  In any case where such contract is for a
  period of more than one year, an appropriate additional rate of  premium
  shall  be  charged  therefor.  Any  such  contract  may  provide for the
  adjustment of the rate of premium based upon the  experience  thereunder
  at  the end of the first period of insurance thereunder or at the end of
  any subsequent period of insurance thereunder and  any  such  adjustment
  may  be  made  retroactive  only for the period of insurance immediately
  preceding such adjustment.
    (c) (1)(A) Any  such  contract  may  provide  that  benefits  will  be
  furnished  to  a member of a covered group, for himself, his spouse, his
  child or children, or other  persons  chiefly  dependent  upon  him  for
  support  and  maintenance; provided that a contract under which coverage
  of a dependent of a member terminates at a  specified  age  shall,  with
  respect  to  an  unmarried  child  who  is  incapable of self-sustaining
  employment by reason of mental illness, developmental disability, mental
  retardation, as defined in the mental hygiene law, or physical  handicap
  and  who  became  so  incapable  prior to attainment of the age at which
  dependent  coverage  would  otherwise  terminate  and  who  is   chiefly
  dependent upon such member for support and maintenance, not so terminate
  while  the  contract  remains in force and the dependent remains in such
  condition, if the member has within thirty-one days of such  dependent's
  attainment  of  the  termination age submitted proof of such dependent's
  incapacity as described herein.
    (B) In addition to  the  requirements  of  subparagraph  (A)  of  this
  paragraph,  every  corporation issuing a group contract pursuant to this
  section  that  provides  coverage  for  dependent  children,  must  make
  available  and if requested by the contractholder, extend coverage under
  that contract to an unmarried child  through  age  twenty-nine,  without
  regard  to  financial  dependence  who is not insured by or eligible for
  coverage under any employee  health  benefit  plan  as  an  employee  or
  member, whether insured or self-insured, and who lives, works or resides
  in  New York state or the service area of the corporation. Such coverage
  shall be made available at the inception of all new contracts  and  with
  respect  to  all other contracts at any anniversary date. Written notice
  of  the  availability  of  such  coverage  shall  be  delivered  to  the

  contractholder  prior  to  the  inception  of  such  group  contract and
  annually thereafter.
    (C)  Notwithstanding  any rule, regulation or law to the contrary, any
  contract under which a member elects coverage for himself,  his  spouse,
  his children or other persons chiefly dependent upon him for support and
  maintenance  shall  provide  that coverage of newborn infants, including
  newly born infants adopted by the insured or subscriber if such  insured
  or  subscriber  takes  physical custody of the infant upon such infant's
  release from the hospital and files a petition pursuant to  section  one
  hundred  fifteen-c  of  the domestic relations law within thirty days of
  birth; and provided further that no notice of revocation to the adoption
  has been filed pursuant to section one hundred fifteen-b of the domestic
  relations law and consent to the adoption has not been revoked, shall be
  effective from the moment of birth for injury or sickness including  the
  necessary  care  and treatment of medically diagnosed congenital defects
  and birth abnormalities including premature birth, except that in  cases
  of adoption, coverage of the initial hospital stay shall not be required
  where  a  birth parent has insurance coverage available for the infant's
  care. This provision regarding coverage of  newborn  infants  shall  not
  apply  to  two  person coverage. In the case of individual or two person
  coverages the corporation must  also  permit  the  person  to  whom  the
  certificate is issued to elect such coverage of newborn infants from the
  moment of birth. If notification and/or payment of an additional premium
  or  contribution  is  required  to make coverage effective for a newborn
  infant, the coverage may provide that such notice and/or payment be made
  within no less than thirty days of the day of  birth  to  make  coverage
  effective  from the moment of birth. This election shall not be required
  in the case of student insurance or where  the  group's  plan  does  not
  provide coverage for dependent children.
    (2)  Any  such  contract under which coverage of a dependent spouse or
  group member would terminate upon such spouse or group member  attaining
  the  age  prescribed  in subchapter XVIII of the Social Security Act, 42
  U.S.C. § 1395 et seq. ("Medicare"), as the age of first eligibility  for
  the  benefits  provided  by  such  law  shall  not so terminate, if such
  dependent spouse is not then eligible for all of such benefits,  for  as
  long  as the contract remains in force and such dependent spouse remains
  ineligible to receive any of such "Medicare" benefits, provided proof of
  such ineligibility is submitted to  the  corporation  within  thirty-one
  days  of  the  date  notice  of termination of coverage is sent by first
  class mail  by  the  corporation  to  the  last  known  address  of  the
  policyholder.
    (d) (1) A group contract issued pursuant to this section shall contain
  a  provision  to  the  effect  that in case of a termination of coverage
  under  such  contract  of  any  member  of  the  group  because  of  (I)
  termination  for  any reason whatsoever of his employment or membership,
  if he has been covered under the  group  contract  for  at  least  three
  months,  or  (II)  termination  for  any  reason whatsoever of the group
  contract itself unless the group contract holder has replaced the  group
  contract with similar and continuous coverage for the same group whether
  insured  or  self-insured, he shall be entitled to have issued to him by
  the corporation, without  evidence  of  insurability,  upon  application
  therefor and payment of the first premium made to the corporation within
  forty-five  days after termination of the coverage, an individual direct
  payment contract, covering such member and his eligible  dependents  who
  were  covered by the group contract, which provides coverage most nearly
  comparable to the type of  coverage  under  the  group  contract,  which
  coverage shall be no less than the minimum standards for basic hospital,
  basic  medical, or major medical as provided for in insurance department

  regulation; provided, however, that if the corporation  does  not  issue
  such  a  major  medical  contract, then to a comprehensive or comparable
  type of coverage which is most commonly being sold  to  group  remitting
  agents.  Notwithstanding  the previous sentence, a corporation may elect
  to issue a standardized individual enrollee contract pursuant to section
  four thousand three hundred twenty two of this  article  in  lieu  of  a
  major  medical  contract,  comprehensive  or comparable type of coverage
  required to be offered upon conversion from an indemnity  contract.  The
  conversion  privilege  afforded herein shall also be available: (A) upon
  the divorce or annulment of the marriage of a member,  to  the  divorced
  spouse  or  former  spouse  of  such  member,  (B) upon the death of the
  member, to the surviving spouse and other dependents covered  under  the
  contract,  and  (C) to a dependent if no longer within the definition in
  the contract.
    (2) The effective date of the  coverage  provided  by  the  individual
  direct  payment  contract  shall  be  the date of the termination of the
  individual's coverage under the group contract.  The  individual  direct
  payment  converted  contract  may  exclude any condition excluded by the
  group contract. The individual direct payment contract shall not exclude
  any other pre-existing conditions but the benefits  provided  under  the
  individual  direct  payment  converted  contract  may  be reduced by the
  amount of any such benefits provided under the group contract after  the
  termination of the individual's coverage thereunder and during the first
  contract  year  of such individual direct payment converted contract the
  benefits provided under the contract may be reduced so that they are not
  in excess of those that would have been provided  had  the  individual's
  contract  under  the  group  contract  remained in force and effect. The
  corporation shall not  be  required  to  issue  such  individual  direct
  payment  converted  contract covering any person if it appears that such
  person shall then be covered by another  individual  contract  providing
  similar coverage or if it shall appear that such person is covered by or
  eligible  to  be covered by a group contract or policy providing similar
  benefits or is provided with similar benefits required by any statute or
  provided by any  welfare  plan  or  program,  which  together  with  the
  individual   direct   payment   converted   contract   would  result  in
  over-insurance or duplication of benefits according to standards on file
  with the superintendent of insurance relating to  individual  contracts.
  The individual direct payment converted contract may include a provision
  whereby  the corporation may request information when any payment is due
  under the contract of any person covered thereunder as to whether he  is
  then  covered  by  another  contract  or  by  a policy providing similar
  benefits or is then covered by a  group  contract  or  policy  providing
  similar  benefits  or is then provided with similar benefits required by
  any statute or provided by any welfare plan  or  program.  If  any  such
  person  is so covered or so provided and fails to furnish the details of
  such coverage when requested, the benefits payable under the  individual
  direct payment converted contract may be based on the hospital, surgical
  or  medical  expenses  actually incurred after excluding expenses to the
  extent they are payable under such other coverage or provided under such
  statute, plan or program.
    In  the  event  the  benefits  provided  or  payable  are  reduced  in
  accordance  with the provisions of this subsection the corporation shall
  return such portion of the premium paid as shall  exceed  the  pro  rata
  portion of the benefits thus determined.
    (3)  (A)  Each  member  in  the insured group, but not his dependents,
  shall be given written notice of such conversion privilege  provided  in
  paragraph one hereof and its duration within fifteen days after the date
  of  termination  of  coverage under the group contract, provided that if

  such notice be given more than fifteen days but less  than  ninety  days
  after  the  date of termination of coverage under the group contract the
  time allowed for the exercise of  such  conversion  privilege  shall  be
  extended  for  forty-five  days after the giving of such notice. If such
  notice is not given within ninety days after the date of termination  of
  coverage  under  the group contract the time allowed for the exercise of
  such conversion privilege shall expire at the end of such ninety days.
    (B) Written notice by the contract holder given to the member or  sent
  by  first class mail to the member at his last known address, or written
  notice by the corporation which issued the group contract sent by  first
  class  mail  to  the  member  at  the  last  address  furnished  to  the
  corporation by the contract holder, shall be deemed full compliance with
  the provisions of this paragraph for the giving of notice.
    (C) A group contract issued pursuant to this  section  may  contain  a
  provision to the effect that notice of such conversion privilege and its
  duration  shall  be  given  by  the  contract holder to each certificate
  holder upon termination of his group coverage.
    (4) A group contract to  be  issued  to  a  social  services  district
  pursuant  to section three hundred sixty-five of the social services law
  by a corporation subject to the provisions of  this  article  need  not,
  subject  to the approval of the superintendent, provide for the issuance
  of individual certificates and may omit  or  modify  any  of  the  other
  provisions  required to be contained in such contract, provided that the
  superintendent deems such omission  or  modification  suitable  for  the
  character of the coverage provided.
    (e) In addition to the conversion privilege afforded by subsection (d)
  of  this  section, a group contract issued by a hospital service, health
  service or medical expense indemnity corporation shall provide  that  if
  all  or  any  portion  of the insurance on an employee or member insured
  under  the  policy  ceases  because  of  termination  of  employment  or
  membership  in  the  class  or  classes  eligible for coverage under the
  policy, such employee or member shall be entitled  without  evidence  of
  insurability  upon  application to continue his insurance for himself or
  herself and his or her eligible dependents, subject to all of the  group
  contract's  terms  and  conditions applicable to those forms of benefits
  and to the following conditions:
    (1) Continuation shall cease on the date which the employee, member or
  dependant first becomes, after the date of  election:  (A)  entitled  to
  coverage  under  title  XVIII  of  the United States Social Security Act
  (Medicare) as amended or superseded; or  (B)  covered  as  an  employee,
  member  or dependent by any other insured or uninsured arrangement which
  provides hospital, surgical or medical coverage  for  individuals  in  a
  group which does not contain any exclusion or limitation with respect to
  any pre-existing condition of such employee, member or dependent.
    (2) (A) An employee or member who wishes continuation of coverage must
  request  such  continuation  in  writing  within  the  sixty  day period
  following the later of: (i) the date of such termination;  or  (ii)  the
  date  the  employee  is  sent notice by first class mail of the right of
  continuation by the group policyholder.
    (B) An employee or member who wishes continuation  of  coverage  under
  subparagraph  (D)  of paragraph four of this subsection must give notice
  to  the  employer  or  group  policyholder  within  sixty  days  of  the
  determination  under  title  II or title XVI of the United States Social
  Security Act that such employee or member was disabled at  the  time  of
  termination  of employment or membership or at any time during the first
  sixty days of continuation of coverage.
    (3) An employee or member electing continuation must pay to the  group
  policyholder  or his employer, but not more frequently than on a monthly

  basis in advance, the amount of the required premium  payment,  but  not
  more  than  one  hundred  two percent of the group rate for the benefits
  being continued under the  group  contract  on  the  due  date  of  each
  payment.  The  employee's  or member's written election of continuation,
  together with the first premium payment required  to  establish  premium
  payment on a monthly basis in advance, must be given to the policyholder
  or  employer  within  sixty  days of the date the employee's or member's
  benefits would otherwise terminate.
    (4) Subject to paragraph  one  of  this  subsection,  continuation  of
  benefits  under the group contract for any person shall terminate at the
  first to occur of the following:
    (A) The date thirty-six  months  after  the  date  the  employee's  or
  member's  benefits  under  the  contract would otherwise have terminated
  because of termination of employment or membership; or
    (B) The end of the period for which premium payments were made, if the
  employee or member fails to make timely payment of  a  required  premium
  payment; or
    (C) In the case of an eligible dependent of an employee or member, the
  date  thirty-six  months after the date such person's benefits under the
  contract would otherwise have terminated by reason of:
    (i) the death of the employee or member;
    (ii) the divorce or legal separation of the employee  or  member  from
  his or her spouse;
    (iii) the employee or member becoming entitled to benefits under title
  XVIII of the United States Social Security Act (Medicare); or
    (iv)  a  dependent  child  ceasing  to  be a dependent child under the
  generally applicable requirements of the contract; or
    (D) The date on which the group contract is terminated or, in the case
  of an employee, the date his employer terminated participation under the
  group contract. However, if this clause applies and the coverage ceasing
  by reason of such termination is  replaced  by  similar  coverage  under
  another group contract, the following shall apply:
    (i)  The  employee  or  member  shall have the right to become covered
  under that other group contract, for the balance of the period  that  he
  would have remained covered under the prior group contract in accordance
  with  this subparagraph had a termination described in this subparagraph
  not occurred, and
    (ii) The minimum level of benefits to be provided by the  other  group
  contract  shall  be  the applicable level of benefits of the prior group
  contract reduced by any benefits payable under the prior group contract,
  and
    (iii) The prior group contract shall continue to provide  benefits  to
  the  extent  of its accrued liabilities and extensions of benefits as if
  the replacement had not occurred.
    (5) A notification of the continuation privilege and the  time  period
  in  which  to request continuation shall be included in each certificate
  of coverage.
    (6) The conversion  privilege  afforded  by  subsection  (d)  of  this
  section  shall  be  available  upon  termination  of the continuation of
  benefits described herein.
    (7) This subsection shall  not  be  applicable  where  a  continuation
  benefit is available to the employee or member pursuant to Chapter 18 of
  the  Employee Retirement Income Security Act, 29 U.S.C. § 1161 et seq or
  Chapter 6A of the Public Health Service Act, 42 U.S.C. § 300 bb -  1  et
  seq. However, a group contract shall offer an employee or member who has
  exhausted  continuation  coverage pursuant to Chapter 18 of the Employee
  Retirement Income Security Act, 29 U.S.C. § 1161 et seq. or  Chapter  6A
  of  the  Public  Health  Service Act, 42 U.S.C. § 300 bb - 1 et seq. the
  opportunity to continue coverage for up to thirty-six  months  from  the
  date  the  employee's  or  member's  continuation  coverage began if the
  employee or member  is  entitled  to  less  than  thirty-six  months  of
  continuation benefits.
    (8)(A)  Special  enrollment period. An individual who does not have an
  election of continuation coverage as described  in  this  subsection  in
  effect  on  the effective date of the American Recovery and Reinvestment
  act of 2009, but who would be an assistance  eligible  individual  under
  Title  III  of  such  act  if  such  election  were in effect, may elect
  continuation coverage pursuant to this subsection. Such election must be
  made no later than sixty days after the date the  administrator  of  the
  group  health  plan  (or  other  entity  involved)  provides  the notice
  required by section 3001(a)(7) of the American Recovery and Reinvestment
  act of 2009. The administrator of the group health plan (or other entity
  involved) shall provide such individuals with additional notice  of  the
  right  to elect coverage pursuant to this paragraph within sixty days of
  the date of enactment of the American Recovery and Reinvestment  act  of
  2009.
    (B) Continuation coverage elected pursuant to subparagraph (A) of this
  paragraph  shall commence with the first period of coverage beginning on
  or after the  date  of  the  enactment  of  the  American  Recovery  and
  Reinvestment  act  of  2009  and  shall  not extend beyond the period of
  continuation coverage that would have been required if the coverage  had
  instead been elected pursuant to paragraph two of this subsection.
    (C)  With  respect  to  an individual who elects continuation coverage
  pursuant to subparagraph (A) of this paragraph, the period beginning  on
  the  date  of  the  qualifying event and ending on the date of the first
  period of coverage on or after the enactment of  the  American  Recovery
  and  Reinvestment  act  of  2009  shall  be  disregarded for purposes of
  determining the sixty-three day  period  referred  to  in  section  four
  thousand three hundred eighteen of this article.
    (f) Any contract and certificate, other than one issued in fulfillment
  of  the  continuing care responsibilities of an operator of a continuing
  care retirement community in accordance with article  forty-six  of  the
  public  health  law, made available because of residence in a particular
  facility, housing development, or community shall contain the  following
  notice in twelve point type in bold face on the first page:
    "NOTICE  -  THIS CONTRACT (CERTIFICATE) DOES NOT MEET THE REQUIREMENTS
  OF A CONTINUING CARE RETIREMENT CONTRACT. AVAILABILITY OF THIS  COVERAGE
  WILL  NOT QUALIFY A RESIDENTIAL FACILITY AS A CONTINUING CARE RETIREMENT
  COMMUNITY."
    (g) In addition to all  the  rights  of  conversion  and  continuation
  otherwise  provided  for  herein, employees or members insured under the
  contract who are also members of a reserve component of the armed forces
  of the United States, including the National Guard, shall be entitled to
  have  supplementary  conversion  and  continuation  rights  in   certain
  circumstances as follows:
    (1)  if  the  employee  or  member  insured enters upon active duty as
  defined in subsection (h) of this section, and  the  employer  or  group
  contract holder does not voluntarily maintain coverage for such employee
  or  member  insured, the employee or member insured shall be entitled to
  have  his  or  her  coverage  continued  under  the  group  contract  in
  accordance  with  the  conditions and limitations contained in paragraph
  seven of this subsection and have issued at the end  of  the  period  of
  continuation  an  individual  conversion  policy subject to the terms of
  this subsection.  The effective date for the conversion policy shall  be
  the  day  following the termination of insurance under the group policy,

  or if there is a continuation of coverage, on the day following the  end
  of the period of continuation.
    (2)  if  the  employer  or  group contract holder does not voluntarily
  maintain coverage for the employee or member insured during  the  period
  of  active  duty, and such employee or member insured does not elect the
  supplementary conversion and continuation rights  provided  for  herein,
  coverage  for  such employee or member insured shall be suspended during
  the period of active duty.
    (3) if  the  employee  or  member  insured  elects  the  supplementary
  continuation  right provided for herein or coverage under the group plan
  is suspended, and such employee or member insured dies during the period
  of active duty, the conversion right provided by this section  shall  be
  available  to  the surviving spouse and children, and shall be available
  to a child solely with respect to himself or herself  upon  his  or  her
  attaining  the  limiting  age of coverage under the group contract while
  covered as a dependent thereunder. It shall also be available  upon  the
  divorce  or annulment of the marriage of the employee or member insured,
  to the former spouse of such employee or member insured, if such divorce
  or annulment occurs during the period of active duty.
    (4) if  the  employee  or  member  insured  elects  the  supplementary
  conversion  and continuation right provided for herein or coverage under
  the group plan is suspended, and such  employee  or  member  insured  is
  either  reemployed or restored to participation in the group upon return
  to civilian status, he or she shall be entitled to resume  participation
  in  insurance  offered  by  the  group pursuant to this section, with no
  limitations or conditions imposed as a result of such period  of  active
  duty  except as set forth in subparagraphs (A) and (B) herein. The right
  of resumption provided for herein  shall  extend  to  coverage  for  the
  spouse  and dependents of the employee or member insured and shall be in
  addition to other existing rights granted pursuant to state and  federal
  laws  and  regulations  and shall not be deemed to qualify or limit such
  rights in any way. No exclusion or waiting  period  may  be  imposed  in
  connection  with  coverage of a health or physical condition of a person
  entitled to such right of resumption, or a health or physical  condition
  of any other person who is covered by the policy unless:
    (A)  the  condition  arose  during  the  period of active duty and the
  condition has been determined by the secretary of veterans affairs to be
  a condition incurred in the line of duty; or
    (B) a waiting period was imposed and had not been completed  prior  to
  the  period  of  suspension;  in no event, however, shall the sum of the
  waiting periods imposed  prior  to  and  subsequent  to  the  period  of
  suspension exceed the length of the waiting period originally imposed.
    (5)  if  the  employee  or  member  insured  elects  the supplementary
  conversion and continuation coverage provided for herein:
    (A) when such employee or  member  insured  is  either  reemployed  or
  restored to participation in the group, coverage under the supplementary
  rights  provided for herein shall terminate on the date that coverage is
  effective due to resumption of participation in the group.
    (B) when such employee or member insured is not reemployed or restored
  to participation in the group upon return to civilian status, he or  she
  shall  be entitled to the conversion and continuation rights provided by
  subsections (d) and (e) of this section.
    (i) To elect an individual conversion contract pursuant to  subsection
  (d)  of  this  section, the employee or member insured must apply to the
  insurer within thirty-one days of the  termination  of  active  duty  or
  discharge  from  hospitalization  incident  to  such  active duty, which
  hospitalization continues for a period of not more than one  year.  Upon
  commencement of coverage under the conversion right provided pursuant to

  subsection  (d)  of  this  section,  coverage  under  the  supplementary
  continuation right provided for herein shall terminate.
    (ii)  To  elect continuation of coverage pursuant to subsection (e) of
  this  section,  the  employee  or  member  insured  must  request   such
  continuation  of  the employer within thirty-one days of the termination
  of active duty or discharge from hospitalization incident to such active
  duty, which hospitalization continues for a period of not more than  one
  year.  Upon  commencement  of  coverage  under  the  continuation  right
  provided pursuant to subsection (e) of this section, coverage under  the
  supplementary  continuation  right  provided for herein shall terminate.
  The employee or member insured shall be entitled to have issued  at  the
  end of the period of continuation an individual conversion contract.
    (6) if coverage under the group plan is suspended during the period of
  active duty:
    (A)  when  the  employee or member insured returns to participation in
  the group plan, coverage under the group plan shall  be  retroactive  to
  the date of termination of the period of active duty.
    (B) when such employee or member insured is not reemployed or restored
  to  participation in the group upon return to civilian status, he or she
  shall be entitled to the conversion and continuation rights provided  by
  subsections (d) and (e) of this section.
    (i)  To elect an individual conversion contract pursuant to subsection
  (d) of this section, the employee or member insured must  apply  to  the
  insurer  within  thirty-one  days  of  the termination of active duty or
  discharge from hospitalization  incident  to  such  active  duty,  which
  hospitalization continues for a period of not more than one year.
    (ii)  To  elect continuation of coverage pursuant to subsection (e) of
  this  section,  the  employee  or  member  insured  must  request   such
  continuation  of  the employer within thirty-one days of the termination
  of active duty or discharge from hospitalization incident to such active
  duty, which hospitalization continues for a period of not more than  one
  year. The employee or member insured shall be entitled to have issued at
  the end of the period of continuation an individual conversion contract.
    (7)  A  group contract providing hospital, surgical or medical expense
  insurance for other than accident only shall provide that if all or  any
  portion  of  the  insurance  on  an employee or member insured under the
  contract ceases because the employee or member  insured  is  ordered  to
  active  duty as defined in subsection (h) of this section, such employee
  or member insured shall be entitled, without evidence  of  insurability,
  upon  application  to  continue his or her hospital, surgical or medical
  expense insurance for  himself  or  herself  and  his  or  her  eligible
  dependents,  under  the supplementary conversion and continuation rights
  provided for herein, subject to all of  the  group  policy's  terms  and
  conditions  applicable  to  those forms of benefits and to the following
  conditions:
    (A) continuation shall cease on the date which the employee, member or
  dependant first becomes, after the date of  election:  (i)  entitled  to
  coverage  under  title  XVIII  of  the United States Social Security Act
  (Medicare) as amended or superseded or  (ii)  covered  as  an  employee,
  member  or dependent by any other insured or uninsured arrangement which
  provides hospital, surgical or medical coverage  for  individuals  in  a
  group,  except that the coverage available to active duty members of the
  uniformed services and their family members shall not  be  considered  a
  group  under  the  terms  of  this  subsection and except that the group
  insurance contract conversion  option  of  this  section  shall  not  be
  considered  as  such  an  arrangement under which an employee, member or
  dependent could become covered.

    (B) an employee or member insured who wishes continuation of  coverage
  pursuant  to  this  subsection must request such continuation in writing
  within sixty days of being ordered to active duty.
    (C)  an  employee  or member insured electing continuation pursuant to
  this subsection must pay to the group contract  holder  or  his  or  her
  employer,  but  not  more frequently than on a monthly basis in advance,
  the amount of the required premium payment, but not more than the  group
  rate  for  the  benefits being continued under the group contract on the
  due date of each payment.
    (8) The supplementary conversion and continuation rights provided  for
  herein shall apply to:
    (A)  contracts  not  covered  by Chapter 18 of the Employee Retirement
  Income Security Act, 29 U.S.C. section 1161 et seq or Chapter 6A of  the
  Public Health Service Act, 42 U.S.C. section 300bb-1 et seq;
    (B)  contracts covered by Chapter 18 of the Employee Retirement Income
  Security Act, 29 U.S.C. section 1161 et seq or Chapter 6A of the  Public
  Health  Service  Act, 42 U.S.C. section 300bb-1 et seq, when active duty
  for reservists and the refusal of an employer  to  voluntarily  maintain
  coverage  for  such period of active duty is not considered a qualifying
  event.
    (h) To be entitled to the right defined  in  subsection  (g)  of  this
  section  a  person  must be a member of a reserve component of the armed
  forces of the United States, including the National Guard, who either:
    (1) voluntarily or involuntarily enters upon active duty  (other  than
  for  the  purpose  of  determining his or her physical fitness and other
  than for training), or
    (2) has his or her active duty voluntarily or  involuntarily  extended
  during  a  period when the president is authorized to order units of the
  ready reserve or members of a reserve component to active duty, provided
  that such  additional  active  duty  is  at  the  request  and  for  the
  convenience of the federal government, and
    (3) serves no more than four years of active duty.
    (j)(1)  Except  as provided in this section, if a corporation delivers
  or issues for delivery in this state a group or blanket  contract  which
  provides  hospital,  surgical or medical expense coverage for other than
  accident only, the corporation must renew  or  continue  in  force  such
  coverage at the option of the contract holder.
    (2)  A  corporation  may nonrenew or discontinue coverage under such a
  group or blanket contract based only on one or more of the following:
    (A) The contract holder or a participating entity has  failed  to  pay
  premiums  or  contributions in accordance with the terms of the contract
  or the corporation has not received timely premium payments.
    (B) The contract holder or a participating entity has performed an act
  or  practice   that   constitutes   fraud   or   made   an   intentional
  misrepresentation of material fact under the terms of the contract.
    (C)  The  contract  holder  has  failed to comply with a material plan
  provision relating  to  employer  contribution  or  group  participation
  rules,  as permitted under section four thousand two hundred thirty-five
  of this chapter.
    (D) The corporation is ceasing to offer group or blanket contracts  in
  a market in accordance with paragraph three of this subsection.
    (E)  The  contract  holder ceases to meet the requirements for a group
  under section four thousand two hundred thirty-five of this chapter or a
  participating employer, labor union, association or other entity  ceases
  membership  or  participation  in  the  group  to  which the contract is
  issued. Coverage terminated pursuant to this  paragraph  shall  be  done
  uniformly without regard to any health status-related factor relating to
  any covered individual.

    (F)  In  the  case  of  a  corporation  that offers a group or blanket
  contract in a market through a network plan,  there  is  no  longer  any
  enrollee in connection with such plan who lives, resides or works in the
  operating  area  of  the  corporation  (or  in  the  area  for which the
  corporation is authorized to do business).
    (G)  Such  other  reasons  as are acceptable to the superintendent and
  authorized by the Health Insurance Portability and Accountability Act of
  1996,  Public  Law  104-191,  and  any  later  amendments  or  successor
  provisions,  or  by  any federal regulations or rules that implement the
  provisions of the Act.
    (3)(A) In any case in  which  a  corporation  decides  to  discontinue
  offering  a  particular  class of group or blanket contract of hospital,
  surgical or medical expense insurance offered  in  the  small  or  large
  group  market,  the  contract  of  such class may be discontinued by the
  corporation in accordance with this chapter in such market only if:
    (i) the corporation provides written notice to  each  contract  holder
  provided  coverage of this class in such market (and to all participants
  and beneficiaries covered under such coverage) of such discontinuance at
  least ninety days prior to the date of discontinuance of such coverage;
    (ii) the corporation offers to each contract holder provided  coverage
  of  this  class  in  such market, the option to purchase all (or, in the
  case of the large  group  market,  any)  other  hospital,  surgical  and
  medical expense coverage currently being offered by the corporation to a
  group in such market; and
    (iii)  in  exercising the option to discontinue coverage of this class
  and in  offering  the  option  of  coverage  under  item  (ii)  of  this
  subparagraph,  the  corporation  acts  uniformly  without  regard to the
  claims experience of those contract holders or any health status-related
  factor relating to any subscribers covered or new  subscribers  who  may
  become eligible for such coverage.
    (B)  In any case in which a corporation elects to discontinue offering
  all hospital, surgical and medical expense coverage in the  small  group
  market or the large group market, or both markets, in this state, health
  insurance coverage may be discontinued by the corporation only if:
    (i)  the corporation provides written notice to the superintendent and
  to each contract holder  (and  participants  and  beneficiaries  covered
  under  such coverage) of such discontinuance at least one hundred eighty
  days prior to the date of the discontinuance of such coverage;
    (ii) all hospital, surgical and medical  expense  coverage  issued  or
  delivered  for  issuance  in  this  state  in  such market or markets is
  discontinued and coverage under such contracts in such market or markets
  is not renewed; and
    (iii) in addition to the notice to the superintendent referred  to  in
  item  (i)  of  this  subparagraph,  the  corporation  must  provide  the
  superintendent with a written plan to minimize potential  disruption  in
  the marketplace occasioned by its withdrawal from the market.
    (C)  In  the  case  of a discontinuance under subparagraph (B) of this
  paragraph in a market, the corporation may not provide for the  issuance
  of  any  group  or  blanket  contract  of  hospital, surgical or medical
  expense insurance in that market in  this  state  during  the  five-year
  period  beginning  on  the date of the discontinuance of the last health
  insurance contract not so renewed.
    (4) At the time of coverage renewal, an insurer may modify the  health
  insurance coverage for a group or blanket contract offered to a large or
  small  group  contract holder so long as such modification is consistent
  with this chapter and effective on a uniform basis among all small group
  contract holders with that contract.

    (5) For purposes of this subsection the term "network plan" shall mean
  a health insurance contract under which the financing  and  delivery  of
  health  care  (including  items  and services paid for as such care) are
  provided, in whole or in part, through a defined set of providers  under
  contract  either  with  the  corporation  or  another  entity  that  has
  contracted with the corporation.
    (k)(1) No corporation delivering or issuing for delivery in this state
  a group or blanket contract which provides hospital, surgical or medical
  expense  coverage  shall  establish  rules  for  eligibility  (including
  continued  eligibility) of any individual or dependent of the individual
  to enroll under the contract  based  on  any  of  the  following  health
  status-related factors:
    (A) Health status.
    (B) Medical condition (including both physical and mental illnesses).
    (C) Claims experience.
    (D) Receipt of health care.
    (E) Medical history.
    (F) Genetic information.
    (G) Evidence of insurability (including conditions arising out of acts
  of domestic violence).
    (H) Disability.
    (2)  For  purposes  of  paragraph  one  of  this subsection, rules for
  eligibility include rules defining any applicable  waiting  periods  for
  such enrollment.
    (3)  No  corporation  may,  on  the basis of any health status-related
  factor in relation to the subscriber or  dependent  of  the  subscriber,
  require  any  subscriber  (as  a  condition  of  enrollment or continued
  enrollment under the contract) to pay a premium or contribution which is
  greater than such premium for a similarly situated  subscriber  enrolled
  in the plan.
    (4)  Nothing in this subsection shall require a corporation to issue a
  group or blanket contract to a group  comprised  of  fifty-one  or  more
  lives exclusive of spouses and dependents.
    (5)  Where an eligible subscriber or dependent of a subscriber rejects
  initial  enrollment  in  a  group  or  blanket  contract  that  provides
  hospital,  surgical  or  medical  expense insurance, a corporation shall
  permit a subscriber or dependent of a subscriber to enroll for  coverage
  under  the terms of the contract if each of the following conditions are
  met:
    (A) The subscriber or dependent was  covered  under  another  plan  or
  contract at the time coverage was initially offered.
    (B)(i)  Coverage was provided in accordance with continuation required
  by federal or state law and was exhausted; or
    (ii) Coverage under  the  other  plan  or  contract  was  subsequently
  terminated  as  a  result  of loss of eligibility for one or more of the
  following reasons:
    (I) termination of employment;
    (II) termination of the other plan or contract;
    (III) death of the spouse;
    (IV) legal separation, divorce or annulment;
    (V) reduction in the number of hours of employment; or
    (iii) Contract holder contributions toward the payment of premium  for
  the other plan or contract were terminated.
    (C) Coverage must be applied for within thirty days of termination for
  one of the reasons set forth in subparagraph (B) of this paragraph.
    (6) With respect to group or blanket contracts delivered or issued for
  delivery  in  this  state  covering  between  two and fifty employees or
  members, the provisions of this subsection shall in no way diminish  the

  rights  of  such  groups pursuant to section four thousand three hundred
  seventeen of this article.
    * (l)  A  health care claim from a subscriber covered under a contract
  issued pursuant to this section shall be submitted  within  one  hundred
  twenty  days from the date of service; provided, however, that if it was
  not reasonably possible for the subscriber to submit  the  claim  within
  that  timeframe, then the claim shall be submitted as soon as reasonably
  possible.
    * NB Effective January 1, 2011
    * NB There are 2 sb§(l)'s
    * (l)(1) As used  in  this  subsection,  "dependent  child"  means  an
  unmarried child through age twenty-nine of an employee or member insured
  under  a  group contract, regardless of financial dependence, who is not
  insured by or eligible for coverage under any  employee  health  benefit
  plan,  whether  insured or self-insured, and who lives, works or resides
  in New York state or the service area of the corporation and who is  not
  covered  under  title  XVIII  of  the  United States Social Security Act
  (Medicare).
    (2) In addition to the conversion privilege afforded by subsection (d)
  of this section and the continuation privilege  afforded  by  subsection
  (e)  of  this  section,  a  hospital  service, health service or medical
  expense corporation or health  maintenance  organization  that  provides
  group  coverage under which dependent coverage terminates at a specified
  age shall, upon application of the employee, member or dependent  child,
  as  set  forth  in  subparagraph  (B)  or (C) of this paragraph, provide
  coverage to the dependent child after that specified age and through age
  twenty-nine without evidence of insurability,  subject  to  all  of  the
  terms and conditions of the group contract and the following:
    (A)  An  employer shall not be required to pay all or part of the cost
  of coverage for a dependent child provided pursuant to this subsection;
    (B) An employee,  member  or  dependent  child  who  wishes  to  elect
  continuation  of  coverage pursuant to this subsection shall request the
  continuation in writing:
    (i) within sixty days following  the  date  coverage  would  otherwise
  terminate  due  to  reaching  the  specified  age set forth in the group
  contract;
    (ii) within sixty days after meeting the  requirements  for  dependent
  child status set forth in paragraph one of this subsection when coverage
  for the dependent child previously terminated; or
    (iii) during an annual thirty-day open enrollment period, as described
  in the contract;
    (C)  For twelve months after the effective date of this subsection, an
  employee, member or dependent child may elect  prospective  continuation
  coverage  under  this  subsection  for  a dependent child whose coverage
  terminated under the terms of the group contract prior to the  effective
  date of this subsection;
    (D)  An  employee,  member or dependent child electing continuation as
  described in this subsection shall pay to the  group  contractholder  or
  employer,  but  not  more frequently than on a monthly basis in advance,
  the amount of the required premium payment  on  the  due  date  of  each
  payment.  The  written election of continuation, together with the first
  premium payment required to establish premium payment on a monthly basis
  in advance, shall be given  to  the  group  contractholder  or  employer
  within  the  time periods set forth in subparagraphs (B) and (C) of this
  paragraph. Any premium received within the thirty-day period  after  the
  due date shall be considered timely;
    (E) For any dependent child electing coverage within sixty days of the
  date the dependent child would otherwise lose coverage due to reaching a

  specified  age, the effective date of the continuation coverage shall be
  the date coverage would have otherwise  terminated.  For  any  dependent
  child  electing  to  resume  coverage  during  an annual open enrollment
  period  or  during  the  twelve-month  initial  open  enrollment  period
  described in subparagraph (C) of this paragraph, the effective  date  of
  the continuation coverage shall be prospective no later than thirty days
  after the election and payment of first premium;
    (F)  Coverage  for a dependent child pursuant to this subsection shall
  consist of coverage that is identical to the coverage  provided  to  the
  employee  or  member  parent. If coverage is modified under the contract
  for any group of similarly  situated  employees  or  members,  then  the
  coverage  shall  also  be  modified in the same manner for any dependent
  child;
    (G) Coverage shall terminate on the first to occur of the following:
    (i) the date the dependent child no longer meets the  requirements  of
  paragraph one of this subsection;
    (ii)  the  end  of the period for which premium payments were made, if
  there is a failure to make payment of a required premium payment  within
  the period of grace described in subparagraph (D) of this paragraph; or
    (iii)  the  date  on  which  the  group contract is terminated and not
  replaced by coverage under another group contract; and
    (H) The corporation or health maintenance organization  shall  provide
  written  notification  of  the  continuation privilege described in this
  subsection and the time period in which to request continuation  to  the
  employee or member:
    (i) in each certificate of coverage;
    (ii)  at least sixty days prior to termination at the specified age as
  provided in the contract;
    (iii) within thirty days of the effective  date  of  this  subsection,
  with  respect to information concerning a dependent child's opportunity,
  for twelve months after the effective date of this subsection, to make a
  written election  to  obtain  coverage  under  a  contract  pursuant  to
  subparagraph (C) of this paragraph.
    (3)(A)  Corporations and health maintenance organizations shall submit
  such reports as may be requested by the superintendent to  evaluate  the
  effectiveness of coverage pursuant to this subsection including, but not
  limited to, quarterly enrollment reports.
    (B)  The  superintendent  may  promulgate  regulations  to  ensure the
  orderly  implementation  and  operation  of  the  continuation  coverage
  provided   pursuant   to   this   subsection,   including  premium  rate
  adjustments.
    * NB There are 2 sb§(l)'s